Prescription Request Form

We have developed an ordering service for prescription medication and food for our North Melbourne clients (only).

Requests for prescription medication and food can be made via phone on 03 9287 6449 or by completing the below order form. Once submitted, Lort Smith – North Melbourne will be in touch with you.

If you are unable to collect your medication order, we can arrange delivery via post. The average cost of postage is $19.

Please allow 3-5 working days for orders to be filled.

Note: Campbellfield Centre client scripts will be filled at Campbellfield Centre.

  • Client details

  • *mandatory field
  • Patient details

  • Prescription food

  • Medication - for existing customers only